The clinical relevance of the presence of bridging syndesmophytes on kyphosis correction and maintenance following pedicle subtraction osteotomy for thoracolumbar kyphotic deformity in ankylosing spondylitis: a comparative cohort study

BACKGROUND The presence of bridging syndesmophytes (BS) in spinal osteotomy region serves traditionally as one critical determinant for selection of osteotomy techniques. While nowadays the proportion of kyphotic ankylosing spondylitis (AS) patients receiving pedicle subtraction osteotomy (PSO) with yet mobile neighboring disc has seen a substantial increase. Literatures investigating the clinical relevance of the presence of BS on kyphosis correction and maintenance following PSO are scarce. METHODS A total of 71 thoracolumbar kyphotic AS patients treated with single-level PSO at our hospital between September 2010 and August 2014 were retrospectively reviewed, 32 of whom were stratified into the BS group (BG). The operative corrections of multiple spino-pelvic sagittal parameters were assessed. Comparison of the contribution of adjacent disc wedging to total correction per PSO segment was made between the BS and non-BS groups (NBG). The correction loss were also evaluated and compared with a minimum 2-year follow-up. RESULTS A significantly younger age (30.97 ± 8.28 vs. 40.31 ± 8.44 yrs., p < 0.001), smaller pelvic incidence (PI) (43.03 ± 10.60 vs. 49.36 ± 9.75°, p = 0.011), greater wedging index of osteotomized vertebra (1.17 ± 0.16 vs. 1.09 ± 0.08, p = 0.011) and larger local kyphosis (19.59 ± 10.84 vs. 13.56 ± 8.50°, p = 0.013) was observed in NBG preoperatively. Patients in BG and NBG accomplished comparable amount of kyphosis correction per PSO segment (40.22 ± 7.09 vs. 43.85 ± 8.71°, p = 0.062). However, the contribution of adjacent disc wedging to total correction per PSO was significantly larger in NBG [8.10 ± 6.19 (18.5%) vs. 1.09 ± 2.88° (2.7%), p < 0.001]. By ultimate follow-up, the global kyphosis (18.26 ± 10.97 vs. 21.51 ± 10.89°, p < 0.05) and thoracic kyphosis (37.95 ± 11.87 vs. 42.87 ± 11.56°, p < 0.05) deteriorated significantly in the NBG but not BG, so was further pelvic retroversion as represented by increased pelvic tilt (19.46 ± 8.13 vs. 23.44 ± 8.19°, p < 0.05) and decreased sacral slope (23.02 ± 9.12 vs. 18.62 ± 10.10°, p < 0.05). Loss of corrections concerning contribution of adjacent disc wedging was also larger in NBG (1.41 ± 3.27 vs. 0.22 ± 1.49°, p < 0.05). CONCLUSIONS Our study might suggest that the evaluation and treatment methods of kyphotic AS patients needed to be fine-tuned with appropriate subgrouping by the presence of syndesmophytes with bamboo sign as they were potentially distinct groups with different PI, contributor of lordosing capability and prognosis that might require separate analysis.